Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
Department of Urology, University Hospital Zurich, Zurich, Switzerland.
Int J Cancer. 2015 Aug 1;137(3):553-9. doi: 10.1002/ijc.29420. Epub 2015 Jan 23.
Recent studies indicate frequent early PSA retesting unrelated of men's baseline PSA, which increases the harms of early detection especially among men with low PSA. The current study investigates the PCa incidence among men with baseline PSA <1.0 ng ml(-1) in order to adjust retest intervals for more targeted early detection. Between 1998 and 2012, 2,416 men with baseline PSA <1.0 ng ml(-1) were prospectively observed. Primary endpoint was PCa diagnosis. Negative predictive value (NPV) and number needed to screen (NNS) to detect one PCa were calculated. During a median follow-up time of 12.1 years, 54 (2.2%) PCa were diagnosed with n = 26 (48.1%) among men with baseline PSA of 0.75 ≤ 1.0 ng ml(-1) (upper baseline PSA quartile). The 10-year probability of being diagnosed with PCa increased significantly from 0.19% (baseline PSA < 0.40 ng ml(-1) ) to 2.0% (baseline PSA 0.40 ≤ 0.56 ng ml(-1) ), 2.5% (baseline PSA 0.56 ≤ 0.75 ng ml(-1) ) over 4.4% (baseline PSA 0.75 ≤ 1.0 ng ml(-1) ) (all p values <0.0001), respectively. The frequency of Gleason ≥7 PCa increased from 1 (0.17%) to 8 (1.4%), 5 (0.8) over 11 (1.8%) in these groups. The 8-year NPV for Gleason ≥ 7 PCa were 99.8 (baseline PSA < 0.40 ng ml(-1) ), 99.8 (baseline PSA 0.40 ≤ 0.56 ng ml(-1) ), 100 (baseline PSA 0.56 ≤ 0.75 ng ml(-1) ) and 99.5 (baseline PSA 0.75 ≤ 1.0 ng ml(-1) ), respectively. During 12 years, the numbers were 99.8, 98.6, 99.2, and 98.2, respectively. Therefore, due to the very low rate of Gleason ≥ 7 PCa, further screening might be omitted in men with baseline PSA < 0.4 ng ml(-1) . Between 0.4 and 1.0 ng ml(-1) , an 8-year interval can be discussed.
最近的研究表明，男性的 PSA 基线水平与早期 PSA 频繁复查无关，这增加了早期检测的危害，尤其是在 PSA 水平较低的男性中。本研究旨在调查 PSA 基线水平<1.0ng/ml 的男性中前列腺癌的发病率，以便为更有针对性的早期检测调整复查间隔。1998 年至 2012 年间，前瞻性观察了 2416 名 PSA 基线水平<1.0ng/ml 的男性。主要终点为前列腺癌的诊断。计算了阴性预测值（NPV）和检出一个前列腺癌所需的筛查人数（NNS）。在中位随访 12.1 年期间，54 名（2.2%）男性被诊断为前列腺癌，其中 n=26 名（48.1%）的男性 PSA 基线水平为 0.75≤1.0ng/ml（上基线 PSA 四分位数）。10 年内患前列腺癌的概率从 0.19%（PSA 基线<0.40ng/ml）显著增加到 2.0%（PSA 基线 0.40≤0.56ng/ml）、2.5%（PSA 基线 0.56≤0.75ng/ml）和 4.4%（PSA 基线 0.75≤1.0ng/ml）（所有 p 值均<0.0001）。Gleason≥7 前列腺癌的发生率从 1 例（0.17%）增加到 8 例（1.4%）、5 例（0.8%）和 11 例（1.8%）。这些组中 Gleason≥7 前列腺癌的 8 年 NPV 分别为 99.8%（PSA 基线<0.40ng/ml）、99.8%（PSA 基线 0.40≤0.56ng/ml）、100%（PSA 基线 0.56≤0.75ng/ml）和 99.5%（PSA 基线 0.75≤1.0ng/ml）。在 12 年内，相应的数字分别为 99.8、98.6、99.2 和 98.2。因此，由于 Gleason≥7 前列腺癌的发生率非常低，PSA 基线水平<0.4ng/ml 的男性可能可以省略进一步的筛查。PSA 基线水平在 0.4-1.0ng/ml 之间时，可以讨论 8 年的间隔时间。
